Have You Secured Coverage in 2018?

How PBMs Hold the Key to Pharmaceutical Success

Recent debates surrounding drug pricing have forced the pharmaceutical industry to navigate multiple avenues ensuring optimal coverage while maintaining high levels of ROI. Though the industry has worked extensively with insurance providers, building positive relationships that encourage better, more affordable healthcare, the industry has yet to build the same relationship with PBMs. Pharmaceutical Benefit Managers may be the key to lower prices, and better access to pharmaceutical in 2017 and 2018. So, how can the industry effectively integrate PBMs?

State of the Industry

In recent years, the insurance industry has stopped recognizing PBMs as the “middle-men” of prescriptions and started initiating positive relationships, sometimes even bringing these industries under the same roof. This relationship means that PBMs, pharmacies, and payors are able to collaborate on coverage and access easier than before. It also means that developing positive payor relationships could pay off with a positive PBM relationship in the long-run.

Establishing price negotiations in pharmacy networks enables patients easier access to medications and a better understanding of their pharmaceutical coverage. Positive PBM-pharma relationships are the key to ensuring ROI while also enabling patient access to crucial pharmaceuticals.

Navigating these relationships requires market managers to gain a comprehensive understanding of how PBMs have impacted the pharmaceutical industry, and how PBM trends could impact the industry moving forward. In a time of uncertain healthcare, securing PBM access can mean the success of a therapy.

PBM & Insurance: What’s Different?

The pharmaceutical industry operates mostly with payors. Investing in these relationships to create positive atmospheres has helped many companies produce and launch groundbreaking medications. The relationship between insurance and PBMs, however, is what secures access and coverage. So how can companies tailor their interactions to build relationships both with payors and PBMs? And why should they?

Under the scrutiny of high drug prices, many PBMs have offered more insight to their processes, namely those involved with negotiations between the pharmaceutical companies and pharmacy networks. Some of these insights point to greater savings for patients, including rebate programs which retroactively save patients on their prescriptions. Negotiating these rebates to lower costs both for the pharmaceutical industry and the patient could encourage a PBM to favor your medical products.

Building relationships with PBMs means building positive ROI for prescriptions, which could factor heavily in drug coverage and wider access while also increasing profits. This is especially significant to in-house PBMs working directly with or under a payor. Early negotiations can help pharmaceutical companies further enable ROI while maintaining coverage and gain a foothold in many pharmacy networks.

The PBM Outcome

Working with PBMs and insurance as a united front to healthcare may seem like a diverted path to the pharmaceutical industry, which has recently increased patient focus and inclusion. Most important to recognize, PBMs share the same goals with insurance providers or the pharmaceutical industry as a whole.